At a press conference at the Executive Mansion Wednesday morning, Governor Pat McCrory marked the next step in the state’s Medicaid reform process — signing the cover letter that accompanied the state’s waiver application to the Centers for Medicare and Medicaid Services (CMS). CMS will now begin reviewing the proposal, which calls for shifting responsibility for the Medicaid program from the state to three statewide managed care organizations and up to 10 regional provider-led entities.
Earlier in the day, NC Department of Health and Human Services (DHHS) Secretary Richard Brajer presented an overview of the final application to the House Health Committee. He told legislators his department had worked with over 50 stakeholder organizations, held 12 public hearings across the state and received comments from over 750 organizations and individuals in developing this final waiver application.
“It’s a beautiful expression of democracy in process,” he said. He noted the strong physician representation at the hearings and among the commenters. Brajer cited their main concern with the proposal as increased administrative burdens in having to work with multiple pre-paid health plans for Medicaid patients rather than simply the state. He said the department was working to put in place approaches to minimize those burdens.
At the hearings and in the written comments, many advocated for expansion of Medicaid, Brajer told the legislators. The waiver application, however, does not include provisions for expanding Medicaid, he said, since the waiver must comply with the reform legislation passed last fall, which does not envision expansion.
While Brajer said the final waiver application submitted to CMS this afternoon is 95 percent similar to the one originally presented, all comments were carefully considered and incorporated where possible.
“I believe we were highly responsive to the comments,” he told the committee. “But we have to live within the same budgetary, legal and legislative restraints.”
CMS may take 18 months to review the waiver, during which time, Brajer said the department will continue to work with all stakeholder groups to revise and improve the application. The North Carolina Medical Society (NCMS) is working to ensure that reform plans fully address clinical priorities of Medicaid patients, ensure physicians have access to clinical and claims data to drive improvements in care, and integrate physician leadership system-wide.
“Democracy in process.” It’s a shame the Founders didn’t have the Secretary’s visionary suppleness, otherwise Medicaid might have found its way into Article 1. Bravo, Mr. Secretary. What a victory for the stakeholders.